chronic-pain-opioid-treatment-report-140929

espect to the percentage of patients achieving stable pain control, the time to achieve stable paincontrol, and the degree of pain control achieved. Another trial found titrated doses of sustainedreleasemorphine plus immediate-release oxycodone slightly superior to fixed-dose, immediatereleaseoxycodone for pain intensity, but no differences on measures of function, sleep, andpsychological distress. 88 Results of this trial are difficult to interpret because maximum doses ofopioids varied in the two arms (up to 200 mg MED/day in titrated dose arm, versus up to 20mg/day in the fixed-dose oxycodone arm), and average doses of opioids were not reported. Noneof the three trials was designed to assess outcomes related to risk of overdose, addiction, abuse,or misuse. Due to study limitations, inconsistent results, and differences between study armsother than use of sustained-release versus immediate-release opioids, the SOE was ratedInsufficient.We identified no study published since the APS review on the comparative effectiveness ofdifferent methods for initiating and titrating opioids.Key Question 3bIn patients with chronic pain, what is the comparative effectiveness ofshort- versus long-acting opioids on outcomes related to pain, function, andquality of life; risk of overdose, addiction, abuse, or misuse; and doses ofopioids used?Key Points• No study compared effectiveness of short- versus long-acting opioids on long-termoutcomes in patients with chronic pain (SOE: Insufficient).Detailed SynthesisThe APS review included a systematic review 89 of seven trials 87, 88, 90-94 of short- versus longactingopioid formulations, but none of the trials met inclusion criteria for the current review. Sixtrials 87, 90-94 were 30 days or shorter in duration and the other 88 was 16 weeks in duration. Five ofthe trials found no difference between sustained-release and immediate-release opioidformulations in pain control. 87, 90, 91, 93, 94 Although two trials found regimens including sustainedreleasepreparations more effective for pain control than regimens restricted to immediate-releasepreparations, results are difficult to interpret because the regimens were not given attherapeutically equivalent doses. 88, 92 No trial was designed to evaluate risk of overdose,addiction, abuse, or misuse.We identified no trials of short- versus long-acting opioids published since the APS reviewthat met inclusion criteria.29